The PerioLase® MVP-7™ for every patient, every day

Transcription: 

Marty Klein: Welcome to Dentistry for the New Millennium. I’m Marty Klein, training manager at the Institute for Advanced Laser Dentistry. My guest today is Dr. Jeremy Ueno, a periodontist in Campbell, CA. Dr. Ueno earned his dental degree from Tufts University in Boston and completed his surgical residency in periodontics at Columbia University in New York City. His practice is in the San Francisco Bay Area and is comprised of multiple surgical specialties. His passion for dental education includes leading multiple study clubs for both dentists and hygienists. He’s a published author and lecturer, both nationally and internationally. Dr. Ueno, thank you so much for being my guest today.

Jeremy Ueno, DMD: Thank you Marty, super excited to be here and I appreciate you guys taking the time to meet with me.

Marty Klein: Of course. Well, you have been a LANAP-trained doctor for about a dozen years. You came to training in 2010. So I want to start before that. Do you remember the first time you heard of LANAP and the PerioLase® and what that was like from that point to deciding to get trained?

Jeremy Ueno, DMD: Yeah. So I did my surgical training from 2006 to 2009. We did not have a laser at Columbia during that time, but people were starting to lecture on it. So we started to kind of get more, open to it. When the PerioLase® first came out… I mean it came out in ’99, I believe. When periodontists were talking about the Periolase® and LANAP, you kind of had two schools of thought:  one was like, they the kind of poo pooed it and others are like, “Oh, this is the future.” I tend to be more on the cutting-edge side. I wanted to really dive in and see if it really was the future. From what I learned from it… I was like, “yeah,” I really want to get to know this better. I think that when I go and start practicing, this would be a big feather in my cap. It would be a big differentiator of what I do versus what anyone else does. When I graduated in 2009, I believe the AAP was in Hawaii in 2010 and my family is from Hawaii. So it was a nice vacation for me to visit family and also learn more about the laser. And again, I’m fresh out of school basically, and I was working at multiple offices. This was the 1st major purchase that I made. It was a major purchase for someone coming out and didn’t have a lot of money. So with that, you know, I can’t believe it’s been 12 years since I bought that, and we bought multiple more since then. But it’s something that I have no regrets about because it was a great marketing tool number one, and number two, the results that we’re seeing. They were pretty phenomenal. We see patients today that I treated 10, 12 years ago that still have teeth in their mouth that we may have done hybrids on back then, but the patient didn’t want to.  They still have teeth in their mouth, and we’ll get into hybrids later as well. But yeah, some of the things that we’re seeing a decade later still blow my mind and the fact that I have two other periodontists that are LANAP trained in my office.  We get to see a ton of great cases. It’s a lot of fun and we use a laser for a lot more than just LANAP nowadays, which is awesome.

Marty Klein: Well, before you get too far down that road, because you gave me a lot there that I want to follow up on. First was that I didn’t realize you did this right out of school. And as you mentioned there in your response, it was an investment. It was something that you had to really decide to do right out of school. And we don’t see that across the board. Do you feel like you were unique among your peers at the time in wanting to differentiate yourself in this way so early in your career?

Jeremy Ueno, DMD: So the funny thing is I looked at the map of the LANAP-trained dentists in San Jose and one was Joyce Litch. Ironically I actually bought her practice out in 2016 and she worked for me for about four years until COVID happened. During that time there wasn’t that many LANAP-trained periodontists in my area. I just felt like if I want to make a name for myself, this is a great way to get to know other dentists in the area and start getting them to refer to me because we know that when you start getting referrals as a periodontist a lot of the cases you’re gonna do are gonna be perio. If you knock the perio out of the park then you might start seeing some implants from those referrals. And so you know my part of the practice is mainly implant-based these days. That all started from doing LANAP, being involved with LANAP, and with our patients going through a less invasive procedure. My communication with the referring dentists as well. For the referring dentist it’s great for them to have their patients come back and go, “Yeah that was way better than getting my gums cut up.” That really helped my practice in terms of marketing and meeting a lot of new dentists in the area to help build up my practice. I opened my own doors January 2011 and I was associating/working at other offices before then. I used to literally put my laser in my car and drive around to different offices and use them. Because of this I already started building a name for myself as being a laser periodontist. That really helped in terms of jump starting my career when I opened my doors.

Marty Klein: So you were never even not a laser periodontist, you didn’t have to unlearn any anything, you know, from before that point, as a lot of doctors who come through training now who maybe practiced without a laser for quite a while, you just decided to start your career right off the bat and doing it sounds like you’ve been very successful so far.

Jeremy Ueno, DMD: Yeah, no, it was again, a decision that I would do 100 times over again. Again, it’s a huge investment. I was with my wife, at that time she was my girlfriend, and she was like, “Oh my God, this is insane.” She’s a dentist, and she encourages it as well. Her being a general dentist, she’s like, “Yeah, my patients would love this,” right? And so again, in my area, not that many people were doing it. So it just made sense to me. I just had to find a way to swallow the pill of what the monthly payment was gonna be and make sure I can afford that. But then again, I saw the ROI a hundredfold since we made that decision.

Marty Klein: You made reference to a couple of other LANAP-trained doctors working right alongside you now. So I know you’re not the only anyone anymore and I believe you even have a second PerioLase®. So can you take me through the growth of the practice in that way?

Jeremy Ueno, DMD: Actually we have three PerioLases®. I mentioned Joyce, when I bought her practice we inherited her PerioLase® as well. So we bought another PerioLase®. Dr. Lynna Bui joined me in 2019. She had her own practice for a while and she’s also working at other offices and so she wasn’t laser trained. However she’s an awesome periodontist and does great perio work. So I said, “I’m doing this, I think you should get involved with it.” So we got her trained and she does a ton of LANAP now. We then brought on Dr. Debra Westervelt in July of last year. She went and got trained at University of Illinois in Chicago, and she didn’t have any laser training as well. We showed her the cases that we did, and we got her trained. That actually was really good because when she got trained, this was 10 years after I got trained. She was telling me things that you guys are teaching. I was like, “I had no idea about that.” Right? So a big thing that helped change me in terms of the way I practice today is her talking about how the laser is used for disinfecting sockets after extractions or implants, or these different things. These are things I never thought about. So the addition of my associates and getting them trained, it really helped me kind of retrain my thoughts on what the laser was used for because before then we’re using it for, you know, if I sprained my ankle I would use it on my ankle. You know things like that. We use it for biostimulation. So the way I was using it was pretty limited to, say, LANAP. I used a diode mode and did some recontouring tissue but I wasn’t using it up to its full potential. Now my part of the practice is heavily implant-based but I use it for almost every one of my implant surgeries today.

Marty Klein: I want to talk about that next. I do need to clarify for those listening that the biostimulation that you mentioned on your ankle in that example is not an FDA-cleared use of the PerioLase® but certainly one that a lot of clinicians use it for outside of the mouth for its additional healing properties. But I do want to turn the attention back to implants because you mentioned a little bit about that and how you are using your PerioLase® in new and different ways. So I want to hear specifically about how you’re using it around tooth extraction sites or before placing implants.

Jeremy Ueno, DMD: Yeah, so my practice is heavily immediate implant based as well. So our goal is always to place immediates if we can. For a lot of people that do implants or do extractions bone grafts, we all know that it’s almost impossible to degranulate some of these sockets just by hand alone. A lot of these cases that have root canal teeth, that have large infections, we can extract, degranulate, bone graft, and when the patient comes back to the implant placement there are times where that bone is softer. And so if you ask anyone that does implants, that that’s always a concern, right? Like you go back in and the bone is not as hard as what you want. That really affects our ability to place a good implant if you want to immediately load the implant, which would affect our decision. In some cases you have to degranulate out the bone graft that you placed because it didn’t turn over. Since we started using this now for our extraction sockets, I’ve noticed this problem is way less, if almost nonexistent now. That being said, it pays for itself just by me not having to use more bone graft because let’s just say I place a bone graft for an extraction and we place the implant 3-4 months later and it’s a little bit soft. We have to remove some, I’ll place the implant and we have to re-graft around it. So that is now a procedure where you’re getting more into the red now. So if I can control the bacteria, time of extraction, get a better bone regeneration outcome, then that reduces the amount of materials I’ll have to use overall. So that to me has been a huge value-add. And especially since we do a ton of immediate implants I just feel much much better when I take the tooth out, degranulate the socket, and use the laser to clean the socket out and then place the implant. Now I know there’s also a way to make the implant hydrophilic. I have not actually done that protocol yet, but it does sound amazing because you know having the implant being hydrophilic versus hydrophobic, you will get better stability, especially secondary stability. And so with that I think that that’s gonna be something that we’re gonna be looking at in terms of what I do in my day to day in terms of using the laser. But again I use the laser for literally every procedure I do during the day. Whereas before I only used it for LANAP. And to be honest, at this point in my in my office, I hardly do any real perio work anymore. Majority of the work I do is gonna be implants. But we do have multiple lasers running around where my two perio associates are using the laser for LANAP and I’m using it for extractions and implants. And I have an oral surgeon, Dr. Thayer, that joined me this year. And it’s exciting because he has a very open mind and he is really interested in learning more about how he can use the laser within his scope of work as an oral surgeon.

Marty Klein: We’ve seen a fair amount of oral surgeons get trained as well. And as you’ve just illuminated, there is more one can do with the PerioLase® than the LANAP protocol. We call those other procedures VAPs, or value-added procedures. And you’ve certainly found several of those to be useful. I noticed on your website that it is at times referred to as a “full-arch” practice and with a “full-arch” training center. So I’d like for you to first tell those listening what that means and then how you folded your PerioLase into that.

Jeremy Ueno, DMD: So in today’s day and age, full arch or “All on X”, Or whatever you wanna call it, hybrids. It’s more and more popular. Especially with Clear Choice centers opening up everywhere and all the marketing they do, patients come in today asking for this type of treatment. And so this treatment is gonna be the removal of all the teeth and remaining implants and placing new implants and putting in some type of full arch prosthesis for these patients. And so our practice has been really forward in terms of the education and training that we do with our local dentists. And now we’re more on a national level in terms of getting our dentists around us to be educated in treatment planning in presenting these cases to their patients and allowing their patients now to accept this type of treatment because as a periodontal office we have a lot of patients that have terminal dentition due to severe periodontal disease. And they’re dentists, they may not be into doing full-arch treatment. So their goal is to just keep these teeth. And what the dentists don’t understand is that these patients are miserable with their teeth because they hate the aesthetics. They hate the black triangles. They hate how long their teeth look. And so with our patients now, if we talk to them and say, you know what, there’s a better alternative and you can look better, you can function better. You don’t have to come back every three months to get cleanings. You don’t have to redo laser surgery on you every X amount of years. And if your disease comes back, then we have this we have this option for you. And I’ll be honest, we have these consults at least weekly in terms of talking to our existing patient base who have severe perio disease and say, Hey, you know what, you’ve been here for 10 years now and you know we see that you’ve done a great job of keeping things clean. But you know, there is a decline in some of these teeth. We’re gonna be losing some teeth which we knew about before. Hey with the LANAP we did, we were able to save some of these teeth for many years. But there is an alternative and that’s gonna be, you know, the full-arch treatment. What we do now is we have a training center curriculum. It’s called Teeth Camp. It’s a two-day program in which day one is gonna be didactic and hands on. The hands-on training that we do includes a photography course. We also do hands on in terms of the restorative side. And on day two, we do a live surgery. So I’ll do a live surgery. So we have a laser next to me as I take the teeth out and degranulate everything and then disinfect everything with the laser. And then we use a laser at the very end to also biostimulate, say, the TMJ, the different injection sites as well. So we use the laser from start to finish when it comes to the full-arch course and then the second day of the full-arch course, we go over marketing with all the attendees. We really appreciate the support of Millennium for the course as well because it allows us to put on a first-class course for the attendees.

Marty Klein: We do like putting on first-class courses ourselves. So you’ve taken a page for sure. I did want to ask about your PerioLase® – as if you’re not using it in enough ways – do you also have one or more of them used in your hygiene department?

Jeremy Ueno, DMD: Yes, we do. So we have three hygienists at our office and we have one Periolase® that then circulates through the hygiene side. So we have one PerioLase® on the hygiene side, two on the surgical side. I have six surgical ops, five hygiene ops, and then we have to consult ops. So 13 ops total. But we’re actually looking to acquire another PerioLase®. It’s just because I’m using it so much for implants that we’re running into running out of the PerioLase® is sometimes when we have multiple docks and multiple hygiene going at the same time.

Marty Klein: No fighting over the PerioLase®, we can always make more. Three is not enough! Lastly, I want to give a plug as well to your book, “Oral Fitness,” primarily about the oral-systemic connection. Something that we discuss regularly on our podcast about gum disease primarily. Can you tell me a little bit about the book and then I’ll inform everyone where they can find out more?

Jeremy Ueno, DMD: Yeah. So, you know, Oral Fitness is a book about the oral-systemic connection. But it’s also a group of stories as well. It’s my story. It’s a story of a bunch of my colleagues that have had experiences with oral systemic connection and oral systemic disease. For me, a lot of my journey came with sleep apnea as well. So I do talk about my journey through sleep apnea. I was fairly overweight for quite some time. And so with that I found a way to increase my health through certain dietary changes, changes in my lifestyle. I also got some help via sleep apnea treatments with my EMT. So I talked about that how that changed my life. We talked a lot about airway in this book. My oldest son has autism and we’ve read studies of how a pregnant mother with some type of sleep apnea has a higher risk for a child with autism. So I do discuss that and I talked about the oral-systemic disease in terms of heart disease. I was in an airplane coming from Las Vegas back home, I was there for a Perio Protect meeting and the guy sitting next to me was in his mid-forties. So same age as me. He was with his family and he had a heart attack and died on the plane. So we try to make all these different connections through stories. Some of my friends have stories about their family members that had Alzheimer’s and how airway affects them, or if they had issues with pregnancy and how the oral-systemic connection can also affect pregnancy. So we link everything to some type of story that all of us as dentists have probably seen within our practice. And so I think that’s what makes the book special is that it’s not just a book on education and giving you facts, it’s personal because, again, these things have affected myself, my family, my friends and their family. That is why I do think that this this book has been successful within our community. Another thing too, because again I do talk about my weight loss journey in it. I have a lot of patients that come back and they go, hey, you know, I read your book and I lost 30 pounds, you know, since I read it because they’ve implemented some of those things that I talked about. So that’s been a really, really fun thing just to see people come in and talk to me about the book, they’ll tell me how it’s changed their lives or how it’s changed their friends lives because that’s what it’s all about. Just want to educate people, let them know what’s out there, let them know that the dentist does more than just look in your mouth and fix cavities. You know we are part of a complete health care team.

Marty Klein: Well that’s so important and so good to hear about and that it’s all available in one place. I do want to direct listeners to your website. UenoDentalCenter.com. There’s a link right on there to the book Oral Fitness. If you’d like to learn more about the full-arch course that we discussed here a few minutes ago, there is a website for that as well, teethcamp.com, and Dr. Ueno will be lecturing later this year (2022) at the D. S. World event in Las Vegas in September, the AAP annual meeting in Pheonix is in late October, and the D. S. H. Q. event in Charlotte. That’s in December. And if you’re listening and you have not yet heard other podcasts that we’ve hosted here with other LANAP-trained clinicians, I invite you to check out our website LANAP.com/podcast. And also, of course, subscribe to the podcast here so that you don’t miss any future episodes. Dr. Ueno, what a pleasure speaking with you today and hearing all about your successes. Thanks so much for joining me.

Jeremy Ueno, DMD: Thank you Marty. I appreciate it.